Mallet finger: Difference between revisions
| Line 1: | Line 1: | ||
==Background== | ==Background== | ||
[[File:PMC4807168 aps-43-134-g001.png|thumb|Possible mechanisms of injury from axial force applied to the tip of a straight digit (black arrows) causing: (top) DIP joint hyperextension (white upper arrow) and fracture, or (bottom) DIP hyperflexion (lower white arrow) and tendon lesion.]] | |||
[[File:Mallet finger.jpg|thumb|Finger in maximum extension]] | |||
[[File:Mallet finger.png|thumb|Mallet finger without fracture]] | |||
[[File:MalletFinger.png|thumb|Mallet finger with fracture at the insertion of the extensor tendon]] | |||
*Rupture of extensor tendon in area of distal phalanx distal to DIP joint | *Rupture of extensor tendon in area of distal phalanx distal to DIP joint | ||
**May be accompanied by avulsion fracture | **May be accompanied by avulsion fracture | ||
*Caused by forced flexion of extended DIP joint | *Caused by forced flexion of extended DIP joint | ||
*If untreated, leads to [[swan neck deformity]] | *If untreated, leads to [[swan neck deformity]] | ||
==Clinical Features== | ==Clinical Features== | ||
Revision as of 02:54, 8 May 2021
Background
- Rupture of extensor tendon in area of distal phalanx distal to DIP joint
- May be accompanied by avulsion fracture
- Caused by forced flexion of extended DIP joint
- If untreated, leads to swan neck deformity
Clinical Features
- DIP joint flexed to 40°, unable to fully extend
Differential Diagnosis
Hand and finger injuries
- Distal finger
- Other finger/thumb
- Boutonniere deformity
- Mallet finger
- Jammed finger
- Jersey finger
- Trigger finger
- Ring avulsion injury
- De Quervain tenosynovitis
- Infiltrative tenosynovitis
- Metacarpophalangeal ulnar ligament rupture (Gamekeeper's thumb)
- Hand
- Wrist
- Drummer's wrist
- Ganglion cyst
- Lunotriquetral ligament instability
- Scaphoid fracture
- Extensor digitorum tenosynovitis
- Compressive neuropathy ("bracelet syndrome")
- Intersection syndrome
- Snapping Extensor Carpi Ulnaris
- Vaughn Jackson syndrome
- General
Evaluation
- Clinical diagnosis
- Consider finger x-ray (PA and lateral) to evaluate for avulsion fracture
Management
- Splint DIP joint in continuous slight hyperextension x 6 wk
- Splinting of the PIP joint is not necessary and should be avoided[1]
- Inadvertently splinting PIP for 6 weeks results in collateral ligamentous overgrowth and functional disability[2]
- Give an extra splint
Disposition
- Discharge with hand surgery follow-up in 7-10 days